From the Guidelines
For an 81-year-old found to be non-immune to rubella but immune to measles and mumps, the next step in management would be to administer the MMR (measles, mumps, rubella) vaccine, as it is the only available formulation containing the rubella component, according to the recommended adult immunization schedule, united states, 2019 1. The patient's age and immunity status to measles and mumps do not preclude the administration of the MMR vaccine for rubella protection.
- Key considerations include:
- The MMR vaccine is generally safe in older adults, with common side effects being soreness at the injection site, low-grade fever, and mild rash.
- The vaccine is important for preventing rubella infection, which can cause complications such as arthritis and encephalitis in elderly individuals.
- Vaccinating this individual also contributes to maintaining community immunity, protecting vulnerable populations like pregnant women, for whom rubella infection can cause serious birth defects.
- Before vaccination, the provider should review the patient's medical history for potential contraindications, such as severe immunocompromise, which would be a contraindication for the MMR vaccine, as stated in the guidelines for immunocompromising conditions 1.
- The standard adult dose is a single 0.5 mL subcutaneous injection, and no special preparation is needed before vaccination, allowing the patient to resume normal activities afterward.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Rubella Non-Immunity
The patient in question is an 81-year-old individual who is not immune to rubella but is immune to measles and mumps.
- According to the study 2, for prevention of rubella, 1 dose of MMR vaccine is recommended for persons aged ≥12 months.
- The study 3 reports on the safety of MMR vaccine in adolescents and adults, which may be relevant for older adults as well, although the mean age of vaccinees in the study was 34.8 years.
- The study 4 assesses the effectiveness and safety of MMR vaccines in children, but the findings on vaccine effectiveness against rubella may be applicable to adults as well.
- The study 5 evaluates the effectiveness of MMR vaccination in reducing hospitalizations for infectious diseases, including targeted and untargeted infections, in children.
- The study 6 provides estimates of seroconversion and waning rates for the measles, mumps, and rubella components of MMR vaccines.
Next Steps in Management
Based on the available evidence, the next step in management for the 81-year-old patient who is not immune to rubella would be to administer 1 dose of MMR vaccine, as recommended by the Advisory Committee on Immunization Practices (ACIP) 2.
- The patient's healthcare provider should discuss the potential benefits and risks of MMR vaccination with the patient, including the risk of local and systemic adverse events 3.
- The patient should be monitored for any adverse reactions to the vaccine and followed up to assess the development of immunity to rubella.